Treating a Nation of Anxious Wimps

Emergency departments are distilleries boiling complex blends of trauma, stress and emotion down to the essence of immediacy: what needs to be done, right now, to fix the problem. Working the past twenty years in such environments has shown me with great clarity what is wrong (and right) with our nation’s medical system. It’s obvious to me that despite all the furor and rancor, what is being debated in Washington currently is not healthcare reform. It’s only healthcare insurance reform. It addresses the undeniably important issues of who is going to pay and how, but completely misses the point of why.
Healthcare costs too much in our country because we deliver too much healthcare. We deliver too much because we demand too much. And we demand it for all the wrong reasons. We’re turning into a nation of anxious wimps.

I still love my job; very few things are as emotionally rewarding as relieving true pain and suffering, sharing compassionate care and actually saving lives. Illness and injury will always require the best efforts our medical system can provide. But emergency departments nationwide are being overwhelmed by the non-emergent, and doctors in general are asked to treat what doesn’t need treatment.

In a single night I had patients come in for the following complaints (all brought by ambulance): “Smoked marijuana and got dizzy”, “stung by a bee and it hurts”, “got drunk and have a hangover”, “sat out in the sun and got sunburn”, “ate Mexican food and threw up”, “picked my nose and it bled, but now it stopped”, “just had sex and want to know if I’m pregnant.”

Since all my colleagues and I have worked our shifts while suffering from worse symptoms than these (well, hopefully not the marijuana), we have understandably lost some of our natural empathy for such patients. When working with a cold, flu or headache, I often feel I am like one of those cute little animal signs in amusement parks that say “you must be taller than me to ride this ride” only my sign would read “you must be sicker than me to come to our emergency department.” You’d be surprised how many patients wouldn’t qualify.

At a time when we have an unprecedented obsession with health – Dr. Oz, The Doctors, Oprah and a host of daytime talk shows make the smallest issues seem like apocalyptic pandemics – we have substandard national wellness. This is largely because the media focuses on the exotic and the sensational and ignores the mundane. Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes and breast implants when we really should worry about smoking, drug abuse, obesity, cars and basic hygiene. If you go by pharmaceutical advertisement budgets, our most critical health needs are to have sex and fall asleep.

Somehow we have developed an expectation that our health should always be perfect, and if it isn’t, there should be a pill to fix it. With every ache and sniffle we run to the doctor, or purchase useless quackery such as Airborne or homeopathic cures (to the tune of tens of billions of dollars). We demand unnecessary diagnostic testing, antibiotics for our viruses, narcotics for bruises and sprains. And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.

Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better. The human body is exquisitely talented at healing. If bodies didn’t heal by themselves, we’d be up the creek. Even in an Intensive Care Unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you gave it plenty of gas, oil and brake fluid, and then expect the transmission to fix itself.

The bottom line is that most conditions are self-limited. This doesn’t mesh well with our immediate-gratification, instant-action society. But usually that bronchitis or back ache or poison ivy or stomach flu just needs time to get better. Take two aspirin and call me in the morning wasn’t your doctor being lazy in the middle of the night; it was sound medical practice. As a wise pediatrician colleague of mine once told me, “Our best medicines are Tincture of Time and Elixir of Neglect.” Taking drugs for things that go away on their own is rarely helpful and often harmful.

We’ve become a nation of hypochondriacs. Every sneeze is swine flu, every headache a tumor. And at great expense, we deliver fantastically prompt, thorough and largely unnecessary care. There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix. A good physician needs to have the guts to stand up to people and tell them that their baby gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat. Unfortunately, this type of advice rarely leads to high patient satisfaction scores.
Modern medicine is a blessing which improves all our lives. But until we start educating the general populace about what really affects their health and what a doctor is capable (and more importantly, incapable) of fixing, we will continue to waste a large portion of our healthcare dollar on treatments which just don’t make any difference.

Dr. Thomas A. Doyle is an emergency physician who practices in Sewickley, PA. He is the author of the forthcoming book “Suck It Up, America: The Tough Choices Needed for Real Health-Care Reform”

your article was 100% accurate and it is a crime that the populace will never be educated about what they do and do not need from the medical profession. we need a system which "just says no" to most persons who do not need any medical attention. unfortunatley this will never happen and we will continue to waste our time and the patients time on needless tests, medications, and the idiotic ,ambulance transportation of people from home or street to the hospital-- just to be sent back to where they came from. I estimate that 99% of the auto accidents that i see in the er dept are sent home. the "lights and siren" tv appearance of prehospital care is also ridiculous. i could go on and on.................as well as could all of our colleagues.

As an RN, I see the exact same thing! I see some of my doctors trying to show the "tough love", but they are so far and few between. Also, as "patient satisfaction" scores keep going down, they are pressured into giving into their every whim.

I'm trying to do my part, too. When patients are demanding to get something for their "dizziness" after I've given them their umteenth dose of IV Dilaudid, I try to educate them or at least just get them to lay down.

But, as you have seen, a lot of patients just don't want to be educated...

I completely agree with your article and have been very vocal with friends and family and patients about my views on health care reform. We cannot expand Medi-Cal and expect our system to survive. Entitled, self righteous, drug seeking or whining patients cannot all be catered to because of EMTALA and a layman's description of a "medical emergency" and if you provide a MSE and find no emergency in their ingrown toe nail (had that one yesterday, foot fungus today, being treated for 24 hours and not better yet), administration will ding us for patient satisfaction scores that are low. I did nothing for either patient mind you other than abx, warm soaks for one and "continue same" for the other.

I was delighted to read your firm yet gentle article; you could not be more right on. Your article is inspiring; I have been considering the possibility of writing a book that ask Americans to take responsibility for their own health and recognize how much they can do for themselves before and after a visit to the doctor.

Maybe there is some truth in one of the above threads that people will not listen, that they will continue to look for that quick and easy pill to make everything better. Still, I believe it is important to continually educate, hopefully gaining one patient at a time until more Americans wake up to the simple truth that medicine is an anchor, an aide to the body's natural healing capabilities.

Thank you for giving me the impetous to begin writing to educate and empower our 'nation of anxious wimps'.

That's what you got from this? The main problem is fat people? Not drug seekers, no inappropriate use of the E.D. Not people coming in by ambulance for sunburn? Not "i'm here for a pregnancy test", just those god forsaken fat people. Not the lack of resources, or lack of motivation, for people to obtain adequate outpatient care. Yep. Just thosane fat Americans. Everything else is hunkey-dorey!

#This is the best thing I have read in a long time —
Karen Bannan @ NaturalAsPossibleMom.com2010-01-05 00:50

I posted to my Facebook page, and tweeted it. If more people read this and followed your advice, we'd take a big step towards stanching the growth of antibiotic resistant germs, healthcare costs, and the overpowering power of Big Pharma.

This Country is very good at going to other countries and teach them how to manage their life but is incapable of doing the same here. All that, thanks to lawyers, who tell people to sue the heck of hospitals and their staff because they didn't give them the diagnosis the wanted. Hospitals administration will always be on the patient side even if it doesn't make any sense. It's a business, not a helping hand. You can't teach people about their weight without having to deal with the administration who receives letters from patients telling them how rude we are. It's really becoming a lost war...

I agree with everything Dr. Doyle said but the patients aren't the only anxious wimps in our nation's ERs. What about the ER docs that fear litigation so much that they admit every chest pain that walks through the door, send every kid with the sniffles away with a handful of antibiotics and give dilaudid out like candy? Of course these doctors are in the minority but the waste adds up and only encourages ER overuse.

A marvellous 100% accurate overview of the problem - its just as bad here in Great Britain. The ultimate source of the problem that has created fearful 'overtreating' Doctors is sleazy ambulance chasing litigatious lawyers.....if Docs and Nurses worldwide went on strike for just a few days we would have the world begging for our services and trash lawyers being chased down the streets. The best form of defence has and always will be to attack!

This is also a response to the pressure put on employed physicians to increase "patient satisfaction scores" like Press-Gainey etc. The idea "the customer is always right" is an expensive mistake in medicine. What the patient wants and what they need is often very different.

Of course no one could disagree with a word you have written, but none of it is new. And in this magazine, you are talking to the converted - wrong forum. America, and Canada as well, gets their emergency room education from the endless TV trash that entertains some, but feeds the public a diet of illnesses and excuses that monopolize emergency wards. Everyone knows that everyone needs to be educated about everything. Now what ?

While I agree with many of your statements in theory, the crack about some people just being "too damned fat" smacks of condescension and ignorance. Are you saying that a person with diabetes II or subclinical hypothyroidism's problem is that they are fat? Obesity in and of itself is not the problem.

Also, I have found that even if I educate myself thoroughly on a health problem (which is what you are suggesting more people do), if I go to a doctor and discuss testing and alternative prevention/treatments I get turned away because I'm not sick ENOUGH yet (and there's no insurance code for that). What ever happened to "wellness care"?

all i can say is that your right. Natural healing is in..haahaif everyone keeps using up money for healthcare, those who are in real need of treatment won't be able to receive what they need ( basically what the article says)

I'm not sure this rant is completely fair from the patient perspective. I just spent a few hours in the ER for chest pains. I spent two days waiting, thinking maybe it was heart burn, but then my arm started hurting and I got sick to my stomach. Everything I read on the web said I should not wait and should go right to the hospital. My local ER was swamped, and they spent a few hours testing me, finding nothing, and then eventually letting me leave. I couldn't help feel a little guilty that I wasted their time - but on the other hand EVERYTHING out there from the medical community on the web tells you to make everything urgent, that you could be dieing. We are also told to consider you guys experts and not really think for ourselves.

So I respect totally what ER doctors and nurses do, but think you guys are part of creating this monster to some degree. I'm still not sure if I should have gone :-).

We are the victims of our own success.We have overcome many sources of true suffering and disease.We want ever improving reduction in suffering and disease and tolerate less and less of it.We create higher and higher standards of service along with not only the expectation but the legal right to absolutely accurate results in the care of every individual.As we do this we create ever more sensitive individuals who suffer more and more from intolerable minor problems (menstrual cramps, vomiting) or the intangible dis-eases(the anxious, the depressed, the worried well)Do not blame the anxious wimps - we have created them as much as Oprah has.I as a provider am struggling to keep up with the demands put on me because NO ONE KNOWS WHEN ENOUGH IS ENOUGH (including me). Quick get that central line into the 86 yr old septic pt because you must keep them alive. You have failed if your statistics are not better and better or not what the institute of medicine thinks they should be in an ideal world. Where are the leaders who do not expect superhuman efforts and will tolerate my mistakes.I am human, I am not perfect but perfection (i.e. 100% success and pt satisfaction) is expected.The spiral will continue until the system crashes. Unfortunately I think I will crash long before the system does.

Apparent to me is how far out of the mainstream of contemporary emergency physician attitudes I have drifted during my 40+ year career in emergency medicine in the inner city public hospital.It has been my lifelong belief that the source of 95% of the problems in any collective human process, including the practice of medicine, can be traced directly to the design of the process, with no more than 5% of the problem originating in the people involved in the process.I have no intention in joining my colleagues in assigning any more than a tiny fraction of the blame for problems in our (non) system of health care to our patients. Our system in fact is little more than a system of illness and injury care, diverted from the much more pressing issue of health promotion by the inappropriate involvement of insurance companies, our legal system, and our political system in an abject failure to design and organize even a system mostly limited to illness and injury care.Patients present to our emergency departments with minor complaints because too many of them have no other access to care, because their payers will cover emergency department visits, and because our system has failed to educate them.These minor complaints very often are the presenting symptoms of significant underlying disease states, most of which could have been prevented by a properly designed system of preventive care, and many of which may be more or less amenable to therapy once established. We all should by now be aware of solid evidence that abuse of tobacco, alcohol, food, and drugs (legal and illegal) are disease states with scientifically documented alterations in brain neurochemistry, physiology, and anatomy. To continue to pejoratively label our patients as misbehaving is to diminish us as physicians.There seems to me, in my advanced age, to be a growing predilection in our society to divisively criticize one another, and to complain about our collective processes, without introducing a reasonable amount of empathy, offering support and encouragement to one another, and suggesting constructive improvements in the design of our systems. We used to speak of things like continuous quality improvement, but this seems to be withering on the vine.Yes, I agree our emergency departments are over burdened, and patients presenting with minor complaints contribute to the difficult state of our already stressed facilities, but can’t we step back, try to gain a better understanding of the problems our patients face, and find a more constructive role in responding to a national crisis in which we spend twice what other developed countries spend on health care and get in return statistics which put us well below most of the others in quality.This crisis cannot be put right by pointing the long finger of blame at our patients and our fellow man. The only solution is to be found in (re)designing our system of health care so that prevention assumes its appropriate role of primacy, and so that every one of us has adequate access to health care (especially primary care).

Thanks for the post! I've been very interested in this topic recently and searching for reading on it. I enjoyed your thoughts. I stumbled upon another blog like I stumbled upon yours. I really enjoyed her take on it: http://www.tchuddle.com/2011/01/a-nation-of-wimps-addendum/

Oh boy, real good article, shouldn't say much but great awesome article. Eventually, don't know how or who will pay for "emergency" treatment for a tiddy cough. Thanks for the information. Agree wholeheartedly.

One night I had a 30ish female admitted to our telemetry unit, chest pain and back pain. She stated she was on disability, and I couldn't for the life of me figure out what she was on disability from. When I asked her, she said it was because she had sleep apnea and scoliosis. Now this woman didn't have lordosis or kyphosis to any noticeable extent, and certainly had no problem hopping from the wheelchair into the bed, twisting around to grab the remote, etc.

"I'm sorry, I don't understand about your disability, I want to make sure you're comfortable tonight, why are you on disability?"

She snorted. "I've got sleep apnea."

"So do I."

"Well, I have to use a machine when I sleep!"

"So do I, did you bring it with you?"

"No, I'm going to use yours."

"How about your scoliosis?"

"I have a lumbar curve."

"Just the one? Any degenerative disc disease?"

"What's that? And when can I have my Demerol?"

"Never mind." I've got 3 curves, am in constant pain due to DDD, and treat it with Motrin, and yet she's the patient.

Emergency rooms overcrowded with non emergencies is just another symptom of the need for updated health care and provision for our working poor. Not everyone who needs assistance is out to take advantage of the system. Many working families are struggling and when they are scared when their child is sick and they can't be seen by a doctor without advanced payment which they probably don't have they take the only options available to them. I can imagine that our emergency room doctors see the dregs of society and it's only natural to become immune to their whining and complaining. There has to be better access to healthcare for all and there had to be some control over the expense. I think this could be accomplished without the US becoming a socialized state. People need to get off the scare tactics and doomsday scenarios and start working toward real solutions. We are looking to Washing to do it for us and that's not going to happen unless big Corporate America pools their resources and make affordable health care a priority. I don't think this will happen either as long as the insurance companies keep fighting any reform that is proposed. I don't have the solutions. I'm not that educated. I do believe that those who have the education, resources and access to research can accomplish this. They have to.

Doc, you have written the story of how all of us in emergency medicine feel. Twenty-eight years ago when I became a medic, EMT's were bringing sick patients into the ER without us because some were afraid we newfangled pre-hospital providers might take their "job" away. We schmoozed them and showed how pre-hospital care for really SICK people can and did make a difference. Now, however, the pendulum has swung so far in the opposite direction that if someone has a "history" of a cardiac problems and their foot hurts, well then the paramedics MUST be called, "just in case." Kinda like the people you described showing up in your ED. In most cases we release these patients but they will get a bill...and insurance pays it, at least for now. All in the name of "what if" or "If I call an ambulance I'll get treated sooner." You're right. People need to suck it up and learn what IS and IS not a real emergency. Kudos for telling it like it is!

I don’t know whether to laugh or cry right now. Our health care system is terribly broken, and for a variety of different reasons we have failed to provide for people. Whether it is community access to health care, information in our schools, information at home, through work, on television, where ever, the system is broken.

The most disturbing thing is that Dr. Doyle, and anyone else following this thread, all think it is ok to blame the patient, because it is easier to do that then to look in the mirror and say that you have failed as health care provider.

How have we failed? We have failed to provide them access to care in a meaningful way, we have failed to provide community education.

We know what the problems are, but we silently sit by and watch. Would you sit by and watch a 4 year old in cardiac arrest? An asthmatic struggling to breath? A 17 year old bleeding to death? Yet you want to give Dr. Doyle a high five, why? Because he vocalizes what you feel? Because if that is the case, I don’t know who I feel worse for, you or him…

Are you in health care manager? Are you doctor, nurse, or paramedic? We see patients every day, and not everyone is hung-over and has a headache, or wants to know if they are pregnant immediately after coitus…some are legitimately ill, but with minor complaints that do not require the services of EMS and certainly do not require the care the emergency department.

But they don’t have community based health care services in the neighborhoods where they live. There are no physicians or clinics, and the clinics they do have access too are too far away. Even if you do have health insurance, and you do have a primary care physician, never mind trying to get an appointment. If you present your concerns, as legitimate as they are in a passionate way, you will still wait a week or two to get an appointment…and if your issue is too serious your primary care doctor will just direct you to the emergency department any way.

This is a feel good article for everyone who works in emergency medical services in this country. It points out what everyone of us see daily and our frustrations with it. It does not point out the cause of the problem. It is an uneducated underemployed population that is often using the only option open to it to receive medical care. The system has engineered a no cost, use it at anytime you don't feel good, don't wait, get the best care in the world system that, to be honest, people would be fools not to use. Why make an appointment with your primary care doctor (if you are lucky enough to have one) to be seen in a week, have to wait 2 hours in the waiting room, and likely pay a copay when you can be seen in the ER at any time? I am as frustrated as you are, but the problem originates because of "educated" people, business and coorporations squeezing the last penny out of a system that is terribly broken, an economy that is leaves people no options and a mentality in this country that everything needs to be fixed and can be fixed with the right pill or shot. No need to suffer, just watch TV and tell me that you need to put up with joint pain, back ache, cold symptoms, headaches, or any other ailment you can regurgitate. Our system is broken, it is managed by a capitalistic system gone wild and is not based on reason, logic or any sense of doing the right thing.

AMEN! I recently, at the age of 52, experienced the ER for the first time in my life for my own needs. I was brought in by my husband when I awoke in the wee morning hours with instant, incredible right flank pain. At first I thought it was repeat kidney stones, but when it did not subside and grew worse, I made a decision to be taken to the ER. Turned out to be a completely blocked right kidney that had developed a cyst which had ruptured. After being initially treated and given pain meds, I was quietly resting when another woman was brought into the 2nd bed in my room - by ambulance. Hearing my roommate’s complaints, I can attest to everything this article said. First, it was obvious she was a repeat ER visitor and always used the ambulance because, not only did the ambulance attendants know her, but so did the ER nurses and their attitudes were definitely ones of frustration and impatience. The patient also stated she was “in here every three weeks” and she knew how things should be done. She was everything this articled talked about and more. Her very lengthy list of non-emergency complaints were random and unrelated issues that were probably due more to her tremendous size and something she had eaten than anything else along with her very poor hygiene as stated by the unfortunate nurse who had to administer a catheter. She demanded instant service from the moment she came into the room and yelled at every person who tried to treat her accusing them of hurting her and doing it wrong, insisting each time that another person be brought in to perform whatever it was they were attempting to do. I came out of this experience with an entirely new respect for ER staff and everything they deal with.

Is it our age, or our education?I had a rollover car accident, as it rolled onto the "panoramic" roof I shielded my eyes because I knew the toughened glass would shatter into little cubes.AS the ar came to rest I looked at my slashed hand (see? proteted my eyes!) and the blood was dripping, not spurting.So I kept it elevated, undid the seat belt left handed, and climbed out the hole in the car.Because you guys educated me.I knew it was bad, but not immediately life threatening. Airbags not deployed, slide and flip 1/4 at a time not a fast roll, no leg/back/neck pain.Of course I was put on a board anyway, I knew it would hurt, you told me so.

My wife spilt a fresh hot tea on her thigh, immediately pulled off the tight jeans and washd it with cold water, then alcohol gel to be sure of cleaning. We went to A&E to be sure our treatment was sufficient and there was nothing below the surface, triage agreed and we went home.

After debriding, flap, and skin graft (and 8 nights on the ward) I was discharged home, with instruction that circulation change (pulse in the back of the hand) temperature change (cold) and colour change were bad and I should go straight back.So when I hit the jackpot of all 3, I went back.Again A&E triage thought it was OK, but couldn't find a pulse; so they borrowed a cellphone sized doppler u/s to find the flow in the reversed artery feeding the flap.Found, reassured I'd done the right thing, and sent home with no treatment other than instruction to come back again if necessary.

So apart from necessary surgery, we used an hour of queueing and 10 minutes each triage.Are we wimps?

No -- you went to an A&E, so you are likely in the UK or from there. You were quickly and appropriately screened for emergencies, and went home appropriately. You didn't come in because you had a hangnail, and your wife didn't have a sunburn. If we could check and send from triage (like you experienced), we could help more people like you who needed to see medical services.

#Shane The Nurse- ER RN in Canada 1999-2002 and US since 2003-present —
ShaneTheNurse2011-12-19 14:59

So much truth here. I am not a fan of satisfaction scores and I am proud that mine are low. The people that are truly sick, the small minority are glad to see me because I am very good at what I do in the ER. The majority, the too stupid to swallow tylenol crowd, hate me and it does not hurt my feelings they give me a low score. So what, most them will never pay the bill which is ridiculously infated anyways. Seriously a 1L bag of Normal Saline cost $1 but get it in the ER and they $100 for the same bag. Hmmmm I wonder why nobody can pay the bill. I could go on, but why? Also, why is healthcare run by insurance companies and not the doctors and nurses that actually see the patient?

I worked in subacute for over 10 years and whenever a patient or family member complained about a staff member (Mom was on call light for 10 seconds before anyone responded; I had to wait 2 minutes for a blanket), management always sided with them and never stood up for us.

In reply to Amber, I'm sure that when the author was commenting on some people just being too fat, he wasn't referring to hypothyroidism. But diabetes type 2? Many times being significantly overweight leads to the diabetes, not the other way around. Obesity is a real problem, and one that needs to be addressed honestly. While a minority of obese or overweight patients have a real medical problem, the sad fact is most are overweight because they are sedentary and take in more calories than they burn, and this leads to diabetes type 2, along with a host of other problems.

This could not be more true, as a paramedic of 23 years in an urban area, this stuff is an hourly event. Please have this article published in every major area around the country, so all may read this.

I was nodding my head the whole way through this article. Couldn't agree more. However, I will say to this author, be careful who you write off as "ok" or "nothing wrong". While most of these people are quite obvious about their unnecessary trip to the ER, some could lead to something. My wife was told for 3 years that her headaches were caused by stress, anxiety, depression, migraines, etc., etc. If they could explain it away, they would. Come to find, when someone actually listened to her complaints, they found she had a brain tumor that was cutting off the flow of CSF from her brain causing immense pressure and said headaches. She never went to the ER for them so I guess my point may be a little mute but while I agree with the author, you have to be extremely careful as to who you write off!

I am not supportive of your rant, I think doctors too often wait for the symptoms to get so bad it is too late. We just lost a family member to ovarian cancer. This had nothing to do with lack of insurance or coverage. She was very proactive in seeking advice and help from doctors. It was simply that the doctors did not do the correct diagnostics and did not listen carefully tp the her complaints and thought they were minor things. Your example of you must be sicker than me is tragic and obviously born from frustration. The symptoms of some serious conditions are simple and it is your job to help, so do not ignore the small stuff, listen to your patients and try to help them, otherwise find a new career.

As a former Paramedic who has had the dubious pleasure (as almost comical as they are but at times the displeasure) of transporting countless individuals with life threatening maladies such as, "My big toe has been hurting for the last three weeks and I know it is 3 a.m. but, I figured you were probably up anyway and I think I need to go to the E.R...." And recently as an Emergency Room RN I have seen the many aspects of the chain of events that lead to the waste, fraud and abuse of our Medical system. Your assessment is spot on and sadly with the looming threat of litigation and the general belief of being "entitled" the hole we are in is as deep as it is wide!

Speaking as someone living in the nightmare of narcotic addiction - I applaud your tough love. I've been in and out of emergency rooms with my husband over the past year and a half, who is "dying" by his assessment. I didn't know what was happening with all of these visits at first (we've been married a year and half, btw). I really just thought he had mysterious ailments (as I, myself, have myasthenia gravis and know that weird things can happen).

This epidemic of "I don't want to 'suffer'" (as if most of us have any idea of what true suffering is) is out of control. I love, love, love the "unlike business, in medicine the customer isn’t always right." We are not customers, we're patients.

When my neurologist told me I had gained too much weight too quickly on prednisone, I cried. I was embarrassed and angry. Then I realized - I was mad because he was right. I was not exercising regularly and needed to suck it up. It wasn't personal or an assessment of my self-worth. It was a fact. Good doctoring, just like good parenting, requires tough love.

Thank you so much for going to work with the FLU and exposing the patients and your colleagues. Wow, what a compassionate person!!Also, the last time I went to the ER (stomach bug, seriously dehydrated), I knew it was a stomach bug because everyone else in the family had it, but the ER people INSISTED I have a CT scan of the abdomen, along with several other tests. So many a lot of patients "demand" expensive tests, but it has been my experience that it's the doctors who request them, I'm assuming to cover their behinds, as it were.I agree that there are waaaaay too many people going to the ER for the wrong reasons, but some of this article just sounds judgmental.

Thanks to the Dr that have the guts to tell us idiots that you will be okay and you do not need a medication for every little thing. I like a safe but conservative view by my physician. I want the meds to work when I need them and not have the usefulness ruined by another person that is a wimp. Thanks for this article.

Just because your a big tough doctor who doesn't feel poison doesn't make you the judge and jury on others pain. So screw you and your judgmental self, many screw the system, but your attitude probably punishes the ones who don't, cause you think everyone is a drug seeker. You have no solution but insults so shut up.

Thank you! I wonder if the physicians I work with feel this way. Sometimes I feel that I am a puppet, being told how to treat people. Don't get me wrong, I LOVE caring the sick, elderly, and the people who need it. I am so tired of being verbally abused. The demanding sense of entitlement that seems to plague our ER's needs to go away. However, the only thing that is changing is how we are expected to treat people, no matter the cost. There is no accountability from insurance companies or management. It's all about volumes and $$$$

I AGREE 100% WITH THIS STORY. THIS IS WHAT HAPPENS TO SOCIETY WHEN YOU HAVE STATE RAN ORGANIZATIONS THAT NEED TO STICK THEIR HEAD WHERE THEY DO NOT BELONG. IT HAS BECOME A SOFTER, GENTLER KINDER SOCIETY WHEN IT COMES TO DISCIPLINE. IT STARTS OUT WITH TRYING TO RAISE YOUR CHILD WITH DISCIPLINE AND SELF RESPECT! YOUR NO LONGER ALLOWED TO DISCIPLINE YOUR CHILDREN. YOU ARE TOLD NY SOCIAL WORKERS (STATE RAN OFFICES) THAT DISCIPLING IS UNACCEPTABLE BEHAVIOR. YOUR CHILD NEEDS DRUGS TO LEARN TO BEHAVE CORRECTLY, THEN THEY SOFTEN OUR MILITARY PERSONNEL BY THREATENING TO DEMOLISH THEIR CAREERS IF YOU LOOK AT YOUR CHILD WRONG. AND SCHOOL GUIDANCE COUNSELORS TELL THE STUDENTS THEY MUST TELL THEM IF THEY GET IN TROUBLE AT HOME AND I'D SO, THEY WILL HELP THEM ESCAPE REALITY IN THE HOME.NOW THE PARENTS ARE LEFT WITH NO CHOICE BUT TO DRAG THEIR CHILDREN INTO A DR'S OFFICE INSTEAD OF BEING ASKED HOW THEY ARE PARENTING AT HOME. NOW EVERYONE IS PUT ON DRUGS IN ORDER TO FUNCTION AS THE MODERN FAMILY. THE CHILDREN ARE DRUGGED TO BECOME ZOMBIES SO THE PARENTS CAN GET OUT OF BEING PARENTS, AND THE PARENTS ARE BEING DRUGGED BECAUSE OF THE GUILT SO NOW THEY ARE EITHER ON ANTI-DEPRESSANTS OR ANTI-ANXIETY MEDS JUST TO COPE WITH LIFE IN TODAYS MODERN WORLD! LIFE WAS SO MUCH SIMPLER IN THE '40'S, '50'S AND '60'S!

Did you read Florence Nitengale's Notes on Nursing? Because you quoted her almost verbatim when you write "optimizing the conditions under which natural healing can occur. " That is a basic nursing theory. Also, same goes for the ICU. People want every symptom fixed. They want every expensive intervention despite the likelihood that grandpa will die anyhow. Why people seem so surprised that an 80 or 85 year old dies is beyond me! "but they were fine before!" they say.... Yeah that is how it works- you are fine then sick!

If you are now burned out on your profession, you need to quit your job, and change your career. People dont go to the ER because waiting for hours on care is fun. They go because they are in pain, and need help. It's not a problem when it comes to your hospital billing insurance companies and collecting co pays. Do your profession and the public a favor. Quit.

I believe much of what you said is legitamate. People should be more proactive in learning how to better care for themselves and stop worrying about worst case scenarios. I have a family member who is an extreme hypochondriac, loves the attention she gets, and takes all kinds of medications...with side effects that further fuel her paranoia. When I was a child, she once gave me half of a vicodin for leg cramps, when what I really needed was a large glass of water, and maybe children's tylenol. I have another family member who dies due to complications of being overweight. The doctors tried to do what they could, but treatment for one ailment counteracted her ability to lose weight. I could blame the doctors, even though they did all they could. I could blame her, even though she battled with her weight since youth. However, I fail to see how playing the blame game will help solve the problem. I now work at educating myself in healthy habits to prevent such tragedy. Yes, I see how you could be frustrated. Drug users exploit ERs painkillers to feed their addiction. People freak out over a cough because they see "TB Outbreak" in the headlines. I know a reactive woman who smoked during pregnancy and still does and can't understand why her toddler gets double earaches and was born with clogged tear ducts. Here comes another big ' however'. However, rather than forming 'sides' in this debate, and pointing our fingers at others, everyone should be thinking of what they could do better. In most problem everyone could possibly benefit from forgetting about the blame game and focus on what, if possible they could do differently. Yes, some people do need to hear difficult truths from their doctors, but its also true that much reform is needed in healthcare. Its been established what patients need to educate themselves, insurance companies need to stop being a pain in the arse, and the media needs to quit with the sensationalism. What can the doctors do to help remedy this problem? In the ER? I know you're underpaid, and overworked, but assuming every person that comes to the ER in less than dire circumstances is a hypochondriac or a drug user is wrong. I experienced it myself. I had extreme pain, and I'm no wuss, and I was very kind and patient. The staff and doctor was surly, and I got very little attention. I was young and had no idea gastrointestinal illness could cause such ridiculous pain. Not rated 10 pain, obviously, but enough to cause concern. Why didn't I go to the doctor? My dad lost his job, and we hadn't any insurance. I later went to see a doctor for what I thought was IBS. He doubted my theory and set me up for a sonogram and an MRI. No negative results. I returned, wanting to know how to alleviate the pain, as I would double over at my fast paced job. The nurse rolled her eyes at my being there. The dr. Was condescending. Went to a different dr. Who prescribed me meds for IBS that were later recalled. I finally got the education I wanted from the interent. I left my high stress job, altered my diet, and the pain slowly went away. What I got from the doctors was procedure bills and faulty medicine. Still, I went away from that experience thinking about how I could've done things differently to better help the doctors help me. Please, do your part, too. For starters, I never think its necessary. To go to work with the flu, cold is fine, but not the flu. Especially when working at the ER, unless you wear a mask and gloves, which I guess I should assume you do. You never know when a patient with immune system issues, or severe asthma comes in with a simple repiratory illness because their body can't handle it like the rest of ours can. Your flu germs could aggravate their problem further.

Right on. Americans have lost common sense and patience. We indeed have been lulled into thinking we can have it all and not pay for it. We want instant gratification, instant cure and instant diagnosis (in the ER no less) or we will complain and be dissatisfied with the care we are given or go to the nearest lawyer to file a lawsuit. Now we have the government and JCHOA requiring that we have high patient satisfaction for adequate reimbursement. The author hit it on the head; Americans need an attitude adjustment or we will bankrupt the country.

While I agree with the article, I have to disagree on your statement that homeopathic medicines are useless quackery. Many homeopathic remedies have been scientifically proven to help the body along in it's natural healing process. These remedies have been used around the world for thousands of years. Homeopathic medicine is not taught in medical school. Medical students these days are taught that only drugs can cure disease. And until we get over this way of thinking,you will have an ER filled with whiney whimps wanting the latest pill to cure their every ache and pain.P.S. I also have a friend who works in a doctor's office, and is a part time EMT, and for every sniffle, she runs to the dr. for a Z-pac! (just in case her cold turns into bronchitis)And guess what?? He gives it to her!

The funniest thing was that if your hospital administration saw this they would probably want to punish or counsel you in some way. It never ceases to amaze me after 16 years in this field how the logical progression to losing empathy is unrealistically punished. I think that is the key to burn out, not the ignorant or silly patients but the being force fed BS about how it is a big no no to tell someone they are being an idiot. These people are the same ones complaining about how much money hospitals are losing and yet insist we treat every indigent and stupid buffoon as if they were a member of freaking Congress visiting out city. When will we ever be able to flush political correctness down the toilet and start refusing to entertain all of the stupidity we are constantly forced to witness with a fake smile and faux kind words about how it's OK? I often say that emergency medicine is like working beneath a rock. Like when you lift up a rock and all of the nasty stuff beneath it starts wiggling. Unfortunately that is an aspect of reality that most people who don't do this job, and are quick to judge us, will never know exists.

Could not agree any more... Well saidI work as a EMT with a private ambulance along with la Co FD I'n Hawthorne and inglewood CA And it never fails we run hundreds of calls that range from c/c my arm fell asleep to GSW's Granted some calls warrant ED but the majority do not! We are an expensive taxi service and often the patient cannot pay the bills there common answer from the patient is "eh ... Medicare will pay" which often does not ! It's frustrating ! I find my self often educating the public when ever possible I believe we have A previalge opportunity to educate them the patients when we make contact. After all we are I'n uniform and wear a badge and resemble some sort of authority ... Reform I'n this Section is a must and hopefully comes soon or we will continue on this path ...

I have never abused an emergency room. And I think it's ridiculous that people do... But you know what? A lot of people can't afford insurance and therefore are not able to see a doc for regular preventative care. They wind up in the ER with their ingrown toenail or whatever symptom the THINK is serious. Let's place more value on making sure EVERYONE can go see their family doc for care of these minor problems so that the ER system is not exploited. We have a system in which preventative care is not emphasized (and often times not covered by insurance)... what do you expect? People watch these trash TV shows and see alarmist reports on TV and think they have a serious problem. Guess what? If they could call their physician we could save a lot of time and money in the ER.

Some truths here, but you sound a bit whiny yourself. Many of these patients aren't getting the Mental Health and other basic care they need and should be referred. To heck with the administrators. They can't fire all of us. People don't care what we say if they know that we care to mis-quote Osler. Have realistic expectations and stay firm, and grounded, but KIND and understanding, too. The patients and you will feel better.

...recently the new, hot thing is to come to the ER for everything, not even related to medical complaints. "My car broke down, I need help finding a ride home", "I don't like my apartment building, can you help me find somewhere else to stay?", "I keep getting into arguments with my son, I need to find out what to do", "I missed my curfew at the homeless shelter, can you call them so they'll let me in?", etc.

So, in short, the nation is wimpy and needs to suck it up, but those who have been in "the system" also possess limited problem-solving skills, which is the true underlying problem here, I think (outside of those just going to the ER for drugs, etc.).

Make them pay for the ride in the ambulance before they are driven to the ER, and pay before entering a treatment room whenever non-emergent. That will end most of this. And while we are at it, get judges with balls to say you will have to pay attorney fees of whoever you sue if you lose this frivalous lawsuit!

I'm noticing that plenty of the naysayers providing comment are not identifying as providers, while the supporters do. Reminds me of my clientele in the ER- trying to second-guess my diagnosis, sure that there is something really wrong, and wanting answers way beyond the scope of practice of the ER. Our primary job is to tell you YOU'RE NOT GOING TO LOSE LIFE LIMB, OR SIGHT BEFORE YOU CAN BE SEEN BY YOUR PRIMARY CARE PROVIDER, SO MAKE ROOM FOR SOMEONE THAT MIGHT! So frustrating to watch those with no deductibles and nothing emergent waltz in because "there's nothing on TV, so let's all carpool to the ER with mildly sick granny and be seen" cross my threshold and clog up the system. Thank God for triage and waiting-room therapy, for my staff is pretty darn good at picking out the sick or injured that need my attention immediately, and leaving all the rest of you naysayers to languish until I can see your mild flu or localized reaction to an insect bite. Sorry psychosomatic sufferers, I respect this Doc and would be proud to be a mid-level under his supervision, but what do I know- I'm just the guy who spent years practicing and going to school in order to diagnose correctly. Burnt out- by no means, ready to give you the boot out of the ER if it isn't going to fit the criteria- in a heartbeat! Visualize making an appointment with primary care or ortho for your sore knee. Try your schtick in every other country I've practiced in ( a lot, and much more often providing compassionate care for the indigenous than ever getting a fee)and see where it gets you! I can honestly say I'm so happy that I practice full-time in a non-emergent specialty and just work 4-6 days a month in the ER to keep my breadth of medical knowledge robust, so I can tell the patient whose daughter is suffering from the ear ache it is a good chance that it's coming from 2nd or 3rd-hand smoke, show the drug seeker his bureau of narcotics enforcement prescription filling record from the last year and say no to any kind of opiate scrip leaving our ER in his hand, or catch the subtle case of new-onset congestive heart failure because I cleared a room for that dying patient because I'm not scared of the PC police. Try these shoes on for size naysayers- I bet you're swimming in them...

it is crazy that we have the #1 healthcare system in the world, yet people still whine about it. Problem: Once Obamacare rationing kicks in (after single payer), patients will have a lot to complain about.

Homeopathy is nothing but quackery. The only evidence is what would be expected when you have dozens of studies showing that it is just a placebo. By normal statistical variation, there will be some that appear to show that there is a real benefit, even though there is not.

Thinking homeopathy works is a mistake due to a misunderstanding of statistics.

Amazing how much worthless information we are taught in school but they do not teach us some simple guidelines for when to call an ambulance or when to go to an emergency room. These basic skills that help a person get through life seem much more important than memorizing state capitols, dates of important historical events, etc... Perhaps we could also teach people how to procure and prepare some healthy meals and tackle this obesity/heart disease /Diabetes /certain cancers epidemic that is costing our nation billions every year and affecting the quality of life of a huge percentage of our citizens. The educational system clearly needs to get involved.

I presented to the ED/Urgent Care once because #1. My back hurt everytime I urinated...which started after one horrific episode of stabbing back pain...possibly the worse pain I've ever felt (yes, the worst) and #2. I was out of network and it was the only place I could be seen where my insurance would cover my "care." I was sincere. I supplied my provider with my info and she so nastily retorted, "Do you want a shot in the back or somthin'?" I replied that all I wanted to know is if there was something wrong, how do I stop the pain (can't mass quantities of Ibuprofen or tylenol be bad for kidneys?) and if I'd be okay to go on a 15 mile walk in a few days. Since I could "pee" on command...I went in a cup and was the provider mumbled something about epithelials...and I was sent away not knowing if I had a UTI (she never said it wasn't) or something more/less serious. I was told "ice n ibuprofen." I could not go on my walk (sleepless nights from the back pain) AND the pain lasted for months (why would I go back as for a recheck/follow up?)...would I seriously consider going back to the ED after being "cared for" that way? Hell NO!! I was seeking some semblance of reassurance, compassion, and medical advice...NOT NARCO!!!! I will not go to the ED unless I am bleeding profusely, there is a bone sticking out of my skin, I am unresponsive, or cannot breathe...any other concerns can wait until the next day...and you are welcome. I agree that people abuse the system...but I sincerely got the shaft during my ED/Urgent Care experience...I didn't deserve it.

Don't forget that our patients don't have 8+ years of schooling to know if they are dying or not. Yes, we know that their sniffles are just a cold. But they hear about people dying from swine flu on the news, and meningitis on the internet. And so they worry. We validate a patient's visit if they are sick. But at the same time we gripe when people wait 4 days before coming in for their necrotic foot ulcer, now septic, or when they come in 24 hours after the start of their slurred speech. We can't have it both ways, and it's better for the patient to err on the side of caution. Remember, we're getting paid to decide sick and not sick. If the patient's could do that, then they wouldn't need us.

#No where is this more true as in workers compensation! —
Adam I 2012-01-01 17:01

I have been treating and pointing out the malingering in WC for ten years now and to the patients that seek medical care for a jammed thumb, sore but not injured low back and occasional tingle in the fingers: get a grip, take an Advil and go back to work. They seem to think we can make 100% of all the pain or discomfort go away magically! I would do that for my own back if I had that magic pill!

I completely agree with this article, but I had an interesting experience with my daughter a couple of months ago. My high school aged daughter had a fever and I kept her home from school. To me, fever = contagious. Still, she wasn't so sick she needed to go to the doctor in my opinion. Just stay home and sleep it off was my thought. Come to find out, it wasn't considered an "excused absence" at school without a doctor's note. So, she got marked down in one of her classes because she was out. Why should I have to take my daughter to the doctor and clog up the pediatrician's office for a simple fever just to prove my parental judgment to the school? Weird, man.

Your article is one giant red herring! We are not a nation of "wimps," nor are we a nation of hypochondriacs. We are a nation of the medically uneducated. The people who go to the ER for all of the non-ER-appropriate maladies you described in your article are none of the people I've ever known in my lifetime. Even the dumbest of the dumb people I have been acquainted with over the years would rather suffer silently at home than drag themselves to the godforsaken ER. In fact, I'm glad that the woman who had sex and wanted to know whether she was pregnant sought some medical advice at all! The real tragedy is that the U.S. government continues to do disastrous things like cut Planned Parenthood funding, which would help that woman learn about things like contraception and reproductive health so that she DOESN'T have to turn to the ER for help. We're making it harder and harder for people who are uneducated about health to become educated. And then we so haughtily call them "wimps" and "whiners" when they're actually being proactive about their health.

I enjoyed reading this article and agree with much of what Dr. Doyle has to say. I find it extremely irresponsible and unattractive, however, for him to brag about working in a hospital while sick with the flu. In an environment where he is constantly in contact with patients whose immune systems are depressed, this is nothing less than negligence. Furthermore, he is missing a major point: Our health care system is too expensive because health care is too expensive in America. In European countries where the currency is nearly equivalent, health care costs much less because it is not about profit. In Austria, for example, doctors visits, drugs, medical machinery, and surgery all cost significantly less. Yet, the average salary of a surgeon in Austria is no less than the average salary of a surgeon in America. The difference is that with National Health Care in place in Austria, hospital administrators and insurance companies are not overcharging clients and taking away obscenely high profits. Eliminate insurance companies, nationalize health care, and put a cap on how much Pharm companies can charge for their drugs (as is done in Europe), and you have eliminated the high price of health care, and doctors can still be paid very well.

Hallelujah about the national care systems! However, as for calling in when you have the flu, there is no option but to go to work. No one can cover for you, usually. We don't work like nursing staff, with a guaranteed number of call ins or sick days. There often is no one else to work. We have to suck it up, put on a mask, and wash our hands a lot. I make sure not to see those who could be immunocompromised, but if there was another way to do it, believe me, physicians would take advantage of it!

Emerg doc with over 25 years experience here. This is what I tell my residents: "At our emergency, we have experienced RN's who have had training in triage, and they look at and talk to and examine patients in order to triage them. And every day they make some mistakes. Some people who look not so bad are deathly ill. Others who they think are sick, are quite all right. This happens every day. We see 150 to 240 patients a day, so we aren't surprised that some errors are made either way. Now in our catchment area, there is over a million people at home right now. Some are waking up with with various ailments. Chest burning, rashes, headaches, abdominal pain, etc., all whom are triageing themselves. Some think their chest burning is heartburn, and stay at home and die of an acute MI. Sadly, they have under-triaged themselves. Other have gastroenteritis, and think they are dying, and call an ambulance. That would be over-triaged. Why should we get upset at those who over triage themselves? It would absurd to think that it wouldn't happen many times a day. If you think about it this way, you won't get as burnt out by people who have over triaged themselves showing up in the emergency.

So I think the Dr. Doyle is a little burned out, and not realistic about what to expect the general public to be able to know and understand about their health. If Dr. Doyle remembered the first few patients he saw as a medical student, he probably came up with some pretty dangerous diagnosis for people who weren't ill at all. I know I did. Now that he has 20 plus year experience, he can see a patient with a rash and know in 2 seconds it's nothing serious. But the patient can't. The patient doesn't have knowledge, or experience with this new rash or headache or whatever. What they have is worries and concerns, and his job is to reassure them that it's going to be ok.

A story that comes to mind. A young man gets belly pain. It isn't that bad, so he goes out drinking. Shows up in my emerg with increased belly pain the next morning. My experienced triage nurse and another emergency nurse assess him, and tell me "he's just drunk". I go examine him. He has a rigid abdomen. I order a plain upright x ray, there is a tiny amount of free air under the diaphragm. I call the surgery team, they take him to the O.R. and he had a perforated duodenal ulcer. Surgery saved his life. So this is the other extreme that the emerg doc in the article didn't address. Someone who doesn't look THAT bad, but in fact is very ill. That is why we are emerg docs, and why we have to grin and bear it when a patient finds a new mole and thinks it's flesh eating disease. It's our job. Get over it.

Preventative health isn't pushed enough. Less pharmaceuticals and processed food would make a huge difference in boosting health. Unfortunately, there's too much money involved, so its doubtful that we'll see a public information campaign on these issues any time soon.

This sounds like a very young and financially inexperienced constituency of patients with complaints such as: “Smoked marijuana and got dizzy”, “stung by a bee and it hurts”, “got drunk and have a hangover”, “sat out in the sun and got sunburn”, “ate Mexican food and threw up”, “picked my nose and it bled, but now it stopped”, “just had sex and want to know if I’m pregnant.”

I am not surprised to find that Sewickley, PA. is indeed a college town with a other Schools (high schools, an academy, etc.) right near the hospital. As such, I think it is a unique situation and a poor representative sample from which to draw any broad conclusions.

Further, the doctor's claim that we've become a nation of hypochondriacs is something right out of a Charles Dickens novel.

A health care worker who spreads cold and flu germs does no one any good, least of all his patients! Spreading these germs to his patients in their weakened condition is unconscionable (assuming of course that some of his patients are "genuinely ill" and not merely the skylarking slackers about which he reports, though according to his little essay, it seems every one is a skylarking slacker except the good doctor). I don't know a single adult who thinks his or her health should be perfect. I have never heard this sentiment offered by any adult.

Beyond this, it has been widely studied and reported that it is the physicians who demand unnecessary repeated procedures, not the patients, and these studies show that the doctors do this not for patient health, rather they do it specifically because they profit handsomely ordering such procedures!

Regarding immediate gratification, instant action society, I am sure, having now read the words of the good doctor, that he will be willing to give away a portion of his earnings to keep the cost of health care down. Am I right? He will then have less immediate gratification than he otherwise might but as a "leader," he should be willing to make this sacrifice.

These are the words of someone who has it too well in his life. He begins with a misrepresentative sample, disparages that sample, shows his own lack of care and concern, indeed a contempt, for his own patients in spreading cold, flu and other germs in an emergency room (is it any wonder so many people get SICKER under such conditions), points the finger of condemnation at patients (his customers from whom he makes his living), shrinks from his and his associates' responsibility for over using services for profit!

Finally, the good doctor completely misses the point of where the other (other than over subscribed doctor required testing) inefficiencies come from in American medicine: Insurance companies who suck an average 35% markup on all medical services in the United States!

Perhaps the good doctor, upon removing his head from his little college town's hind quarters in Podunk, PA and looks into the broader country might reconsider his shallow and thoughtless assessment of the situation, lest we find him offering us a "Modest Proposal (ala Jonathan Swift)" in his next, less than objective essay.

This sounds like a very young and financially inexperienced constituency of patients with complaints such as: “Smoked marijuana and got dizzy”, “stung by a bee and it hurts”, “got drunk and have a hangover”, “sat out in the sun and got sunburn”, “ate Mexican food and threw up”, “picked my nose and it bled, but now it stopped”, “just had sex and want to know if I’m pregnant.”

I am not surprised to find that Sewickley, PA. is indeed a college town with a other Schools (high schools, an academy, etc.) right near the hospital. As such, I think it is a unique situation and a poor representative sample from which to draw any broad conclusions.

Further, the doctor's claim that we've become a nation of hypochondriacs is something right out of a Charles Dickens novel.

The doctor seems to be doing his level best to drive up the cost of medical care, himself. A health care worker who spreads cold and flu germs does no one any good, least of all his patients! Spreading these germs to his patients in their weakened condition is unconscionable (assuming of course that some of his patients are "genuinely ill" and not merely the skylarking slackers about which he reports, though according to his little essay, it seems every one is a skylarking slacker except the good doctor). I don't know a single adult who thinks his or her health should be perfect. I have never heard this sentiment offered by any adult.

Beyond this, it has been widely studied and reported that it is the physicians who demand unnecessary repeated procedures, not the patients. These studies also show that the doctors do this -not for patient health, rather they do it specifically because they profit handsomely ordering such procedures!

Regarding the doctor's "immediate gratification, instant action society," comment I am sure, having now read the words of the good doctor, that he will be willing to give away a portion of his earnings to keep the cost of health care down. Am I right? He will then have less immediate gratification than he otherwise might but as a "leader," he should be willing to make this sacrifice as an example to the rest of us wretched and lost souls.

These are the words of someone who has it too well in his life. He begins with a misrepresentative sample, disparages that sample, shows his own lack of care and concern, indeed a contempt, for his own patients in spreading cold, flu and other germs in an emergency room (is it any wonder so many people get SICKER under such conditions), points the finger of condemnation at these same patients (read: his customers from whom he makes his living) and shrinks pusillanimously from his and his associates' responsibility for over using services for profit!

Finally, the good doctor completely misses the point of where the other (other than over subscribed doctor required testing) inefficiencies come from in American medicine: Insurance companies who suck an average 35% markup on all medical services in the United States!

Perhaps the good doctor, upon removing his head from his little college town's hind quarters in Podunk, PA and looks into the broader country might reconsider his shallow and thoughtless assessment of the situation, lest we find him offering us a "Modest Proposal (ala Jonathan Swift)" in his next, less than objective essay.

@ Emergdoc, thank you, I agree with your comments! Patients don't necessarily know what's of grave concern and what is not; that is, in fact, OUR job! I actually enjoy the part of my job that involves education and reassurance, when appropriate. To me, that's part of being a healer, and not just a walking medication dispenser. The moments when I feel burnt out and cynical like this article's author, I try to take a step back and understand that a) the pt probably has better things to do than wait hours to see me, so they really do need my help to some capacity, and b) how would my own health care seeking patterns look if I did not have all of the medical education that I have? In other words, we often (and inadvertently) assume that our pts know as much as we do. And that's not fair.

Due to EMTALA, lack of access/payment for healthcare, patient satisfactions scores and litigation we can't triage a patient and then say, make an appt with your PMD, find a PMD, or go to urgent care. We end up having to see this ridiculousness through to the end to avoid retaliation and address a slew of other "oh and by the way.." complaints throughout the visit. I know people come to the ER with stupid complaints because they need SOMETHING. Most of the time it is emotional support and they have nowhere else to go. But we can't be their 15 min. psychiatrist/psychologist and change their lives when we have a person that's bleeding out, having a heart attack, septic, etc. and not enough staff to cover it. There needs to be a place for these people to go. Community centers, better access to mental health services, hotlines, more affordable health care that allows people to seek prevention or go when they are having a "crisis" that is not a medical emergency. I know we will still have the patients that come in with the bug bite because they don't know any better and it is our job to triage and educate them, but with a better system in place there would hopefully be less of this. And in response to what keeps coming up about people having better things to do than wait in the ER that often simply is not true! Some people really don't have anything better to do and that's why they are there. They are homeless, they don't have a family, their family doesn't listen to them, they just want someone to listen to them and validate them. That is why they come to us. But the system is simply not set up to deal with all of this. And in response to going to work with the flu...All the people who are writing this are obviously not providers because if they were they would know that every time a healthcare worker got the flu and if they didn't show up to work there would be no one to take care of/see patients. And there is such a thing as wearing a mask/gloves/handwashing. And finally.... I agree with what some people are saying about doctors not being God. Everyone is human. I am sorry for the people who's diagnoses of cancer got missed, but vague complaints are just that. Maybe they were written off by their providers because they are burnt out and really don't care or maybe they weren't given the correct diagnosis because we are human beings and every vague complaint that is worked up according to standard of care and also above and beyond that, will not necessarily lead to answers. We aren't Gods and we don't have the answer to everything and the public needs to understand this. And cancer, although serious and life threatening is not an emergent condition that needs to be seen in the ER. I've seen patients come in to ER to get worked up for Lupus. Again, serious and terrible disease but NOT emergent. This again points back to lack of access to primary care or just plain ignorance but still not what the ER is designed for. But the ER still has to deal with and try and play that balancing act of not getting sued/ satisfying patients while having the time/staff/resources to care for those who need emergent care. I can run around to the my three crashing patients while getting yelled at by my patient that is there for the non-emergent problem that the MD took 5 mins to see but I am still at their beckon call for the next 5 hours for sandwiches, to hand them the thing they dropped on the floor, to find the case manager because they need a new apartment, and so on. This is stuff the doctors often don't see and also don't realize that we don't have the resources for this and the sick patients suffer and wait because the loud angry obnoxious person needs help now! But no we just need to take time to "educate them and reassure" them. When realistically this cannot happen except at the expense of sacrificing the quality of care of those who need it. Idealism is nice but people need to understand the reality of our situation in this country.

Although there are some good and valid points here...I personally have been through the health care system and had many doctors who were too busy to deal with me, left me waiting hours in the waiting room, and just wanted to solve my problems by prescribing me medicine when I made it clear to them I wanted to get better so I did not have to take medicine or that I wanted a more homeopathic approach and they just continued to treat me as though I was being difficult.

Unfortunately I only received a PhD and not my MD but I see the points you are trying to make. I see it every day at my institution. How dare these kids fresh out of high school come into my college and waste my time, 50% of them aren't even capable of completing college; while another 25% may graduate but will never use the degree that they have received. Why do they even try? They could buy the books and read them their selves. I think that only 3.5 GPA and above students who are interested in the content of my classes should be allowed to continue on in higher education.

Oh wait. I became a professor to teach, as I am sure you become a doctor to treat people. I am really sorry that a vast majority of your patients are not sick enough to keep you interested in your work (I suppose not every doctor is House MD running around solving only the important stuff). The only anxious wimp I see here is a doctor with a God Complex who has the nerve to blog about his lack of interest in the path he has chosen.

All doubts about how "doctors" feel about their patients should be eliminated after reading your rant. If you didn't act like you were "god" then the expectations patients have about what you can do for them wouldn't be so high. If you feel this way about medicine then you should sell a few office buildings and stock options and return the money to the people you have mistreated in such a horrific manner. Every one of your patients knew how you felt about their illness but they were polite enough to let it slide. Some day you will be sick....really sick......and someone on the other end of things will tell you to "suck it up." More likely it will be someone you care about deeply or love. You have a lot to learn and shouldn't be practicing medicine. Any of your doctor friend who encourage your comments here on this board should also return the money they have stolen from patients. If a body heals on it's own without medicine and you know that to be the case then you are committing fraud by taking money for doing something that you know is unnecessary. IMHO of course.

I work with troubled teens; and I see more and more Clients who are diagnosed with "Bi-polar, ADHD, DEPRESSSION, etc etc etc..." ~ and the main part of their treatment is pumping them full of pills and chemicals to "balance them out". I also have many Clients who take pills to conteract the side effects for the pills they take for "depression", and pills to counteract the pills that counteracted the last pills, and pills to counteract those ones, etc... at the end of the day, these kids (and I'm talking 11 and 12 yrs old some of them) are pumped full of so many chemicals that they can't function with out them!~ and most of them, are depressed for good reasons, and just need to learn better coping skills, ideas, and just better ways of THINKING! ~ along with some strong positive romodels in their lives, healthy foods, deep breathing and exercise. Good habbits start young, and can last a LONG lifetime! :-)

Part of the problem is that when we call the hospital advice nurse line with breathing problems, etc. we are almost always told to proceed to the ER. There are many many cases when I've been told to go to the ER when it wasn't really necessary in my humble opinion. I usually refuse - unless I'm blue, bleeding, or in debilitating pain, it's not worth waiting in line. I'll just call the doc. the next day.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

I would love to see you go to Washington, D.C. and tell our Congressmen and women this very same thing. You are absolutely right. Although not all of us fall into this trap, I witness on a daily basis this being the issue. I don't know how doctors (especially ER docs) DON'T lose it with people who have too much time on their hands and run to the doctor for every little thing.

I must disagree on one point, however. I do believe in holistic medicine and preventive alternatives, some of which do work. I agree that there are "snake oils" out there of which people should beware. However, good nutrition, supplements where needed, exercise and listening to one's body is the best preventive medicine.

Thank you for your honesty. If we had more like you, we'd not be in the health care mess we're in, I'm sure.

Is it as bad as this? If it is, it will impact on the real emergencies and make the doctors insensitive. I do not agree wholeheartedly with the pediatrician quoted, as a mother's instincts are not to be poo-pooed. Quote: "As a wise pediatrician colleague of mine once told me, “Our best medicines are Tincture of Time and Elixir of Neglect.” Sometimes there are real emergencies that show up as a little bit of vomiting and unable to eat food in babies that turn out to be life-threatening. Luckily, my physician listened to me and my baby was saved. Also, as happened here and if I remember correctly, a regular visitor to the ER here ended up dying as they had seen him so many times and left him for extended hours in the waiting room. I think doctors need a whole lot of wisdom....not to harden their hearts. It is tough to be work in this system and also not be put off by the people who misuse, as some patients will fall through the cracks and be sent home with serious consequences. Please keep that sixth sense if you are an emergency physician and resist becoming jaded.

Dr. Doyle, I am really interested in your book when it comes out. Having worked in the ED for 15 years, I have seen just about everything. While there are a select few that scam the system, I have found most patients just want to be heard and a little compassion. Unlike a few responses that take pride in their low patient satisfaction, I find that being honest and educating (some of the basic functions of nursing) is the best for both parties. Have I had a twenty year old ask for Vicodin for a bruise? Absolutely. Do they get it? No, but after educating why ibuprofen, ice and rest work better I not only help this injury but teach what to do if this happens again. I agree with you that we do need to look at our healthcare system. The current system entices incoming students with big paychecks and few hours of work in areas such as plastic surgery leaving less and less of the graduating class in primary medicine. You are right on point that society states you must always be happy and ready to have sex at anytime or something is wrong. I, like you, feel that the staff and the patients are just products of a broken system. It has nothing to do with being "burnt out" as a physician or being a "stupid patient". Until we start to focus (and pay for) basic wellness and have time for the staff to spend with patients and families, the EDs will be swamped with people wanting help. As the professionals, we have to remember that each patient wants and needs the same respect we crave.

I agree completely. It should however be noted that it is big buisiness and lawyers who want to propagate this need for a pill to instantly solveany little hiccup we may have, and want us to believe our health should be perfect, or it's the fault of the doctor. I often see my colleagues saying things like "why do these people Come to the er for this" or "this idiot came in for a hangnail". It is often very hard for us to accept that the problem is much bigger than it just being a patient issue.

written by PhD , January 09, 2012Unfortunately I only received a PhD and not my MD but I see the points you are trying to make. I see it every day at my institution. How dare these kids fresh out of high school come into my college and waste my time, 50% of them aren't even capable of completing college; while another 25% may graduate but will never use the degree that they have received. Why do they even try? They could buy the books and read them their selves. I think that only 3.5 GPA and above students who are interested in the content of my classes should be allowed to continue on in higher education.

Oh wait. I became a professor to teach, as I am sure you become a doctor to treat people. I am really sorry that a vast majority of your patients are not sick enough to keep you interested in your work (I suppose not every doctor is House MD running around solving only the important stuff). The only anxious wimp I see here is a doctor with a God Complex who has the nerve to blog about his lack of interest in the path he has chosen. Thank You!

Dr. Doyle,Keep it up! I am sorry that so many of the people commenting miss the point completely. I agree with those who have posted that this should be required reading and should be published in every newspaper in this country!

i agree with the main point of the article but it misses the true cause...patients aren't this way because they are inherently stupid or needy "wimps" but precisely because they are educated by the for-profit health care system to be this way and have been for quite a while now. the author really should be aiming his comments at his fellow professionals, not patients, but that alas is much harder to do.

Good luck with that educating gig. I have a sneaking suspicion that this article's author is none other than the famous Dr. Doyle T., writing under a pseudo name. Regardless, the man is on point but the cure isn't possible, unless the treatment becomes conditional upon the presence of a real medical emergency (i.e. "you sick, we pay; you be wimpin, we be skimpin" :-)

Wow -- I do love this article and -- agree -- it should be posted in every doctor's office, hospital, social services network. As an 80 year old minister, counsellor, hypnotherapist, writer, veteran, mother, grandmother, friend, neighbor, I do so agree with Dr Doyle.

I am writing a book which I call 'Gullible's Travels' -- and it includes a title -- 'Take Two Aspirin and Call Me In the Morning'. It is only one chapter in the propadanda and 'fear' based approach to almost -- oops - 'everything' thrown at us -- from the government having to do war to protect us and develop/buy 'democracy' for countries who have lived for centuries with their laws and culture and don't want to change but will pretend as long as we shovel money in their direction; to the government spending billions to find a cup of water on the moon; (to do what? We can never inhabit Mars or the Moon because it costs about a billion dollars for one spacecraft that might hold 4 people -- we need to tell Gingrich that); to doctors and pharma who have the 'newest', 'improved', 'bestest' product to control our minds and the minds of our children (ritalin, prozac? really??), and pocket books.

We must include in the fear mongering the lawyers who scour the medical profession for 'new' illnesses for us to sue for and every pimple on our collective asses to 'prescribe'. And it goes on.

Soooo -- is there an answer? Not unless we find a way for government to stop 1)playing with real soldiers lives and filling somebody's coffers with billions of profit from war toys, i.e. guns, clothes, tanks etc) to stop 2)playing 'rockets'for research to do what? Phoney, false, faux, airy fairy goals.

Stop the bleeding of our country's wealth, integrity and humanity by Wall Street, by pharma who 'buy' Congress, and, who I consider pimps for Wall Street.

Harsh language?? Not really. At 80 I find it so much easier to be honest with my words and my own truth. If not now, when?

There are thousands of 'good' doctors, lawyers,judges, patients etc. They consist of what the newspapers call 'soft' news. And, I guess, just like their 'private' parts -- soft doesn't sell or perform as well ---- moneywise.

Wow. You really tell it like you feel it is. I definately feel your frustration. Maybe you should get out of the ER. From my experience emergency rooms are only for obvious problems. Anything not broken, bleeding or blue from lack of oxygen then forget it. My granddaughter who had a serious heart defect was taken to an ER. Her parents were told "she has a cold. Take her home". They didn't believe that and went to the next town to another ER where they actually listened. Surprise! she was in heart failure and almost died that day. She did die a few weeks later waiting for a heart transplant that never came. So you had better look at the other side of the coin too. Those who are left without important care because of health care ' professionals' who are so busy feeling superior that they miss vital symptoms.

I have worked abroad in a socialized medicine country for about 2 years and clearly see a difference in cultural attitudes about what is important in health care. We spend too much time on door to drug time and antibiotic time and Pat Sat scores and not enough time on the simple preventative things. Also individual responsibility is just about gone totally from the US mentality. My dad used to tell me "you can't teach a pig to sing, it doesn't work, and it irritates the pig". And now we learn the sacred patient satisfaction scores are clearly associated with higher mortality and costs. I have been against such bullocks for years and am usually straight forward with patients. Yes I have a few low scores but I sleep at night knowing I have given solid advice for good health based on my knowledge and experience. We must get over ourselves and we need more open discussion about this topic. I find I agree with the writers opinion pretty much completely and most rank and file EPs would as well. For the dissenters.....good luck.

I started working ambulances as a basic EMT in 1975, became a paramedic in the 80s and then started working in the oil and gas industry, mostly international, since then. I have seen the steady decline in the overall health of our nation during that time and the trend has accelerated in the last couple of decades.

Taking medications (heavily advertised) for every little ache, pain and discomfort, we have became a nation of weak and needful things that circle the parking lot of the mall looking for the closest parking space to avoid walking an additional 25 yards to the door.

We have become weak and needful things and to be honest, I'm glad to be in Egypt working than seeing this on a daily basis in the US.

I appreciate Dr. Doyle's honesty and hold a measure of sympathy for his obvious frustration. There are certainly those who abuse the system. He and the many posters here have added significantly to my knowledge tonight.

On my one adult trip to an ER as a patient, I have to say that I was treated with compassion and decency throughout. I was short of breath, had chest pains and was quite honestly a bit scared. I drove myself in more out of stubborness than anything else. I was taken back pretty quickly but had to wait for some time as more serious situations arrived.

People kept stopping by to let me know where things stood. Most apologized for making me wait. I tried to maintain a sunny demeanor and mostly succeeded, but like I said, I was a bit scared. I'd never felt like that before.

A few hours went by, and I had a scan and some blood work done - all suggested by the ER docs. Eventually, a youngish fella came in to tell me that he didn't have any big dramatic news for me - that I should see my regular MD soon, and that she would probably want me to do a stress test. He was oddly apologetic about that statement, and it confused me at the time. I remember telling him that this wasn't the sort of report he needed to apologize for delivering. He laughed and said not everybody wants to hear that sort of thing.

These same frustrations are felt by so many in the healthcare industry. Every one of us who reads this feels the pain and we only wish every health consumer could just understand. Thank you for getting your valued opinions out there. We need to get it out there even MORE!

I think people who are commenting negatively on here are missing the point. People today feel like they are special, that their problems are more urgent and important than others, and that nothing is ever their fault. "But doctor, even though I got drunk last night, now I have a headache and google said that headaches can be a sign of brain cancer!" If I went to the ER for every symptoms that COULD be a sign of something else, I'd spend half my life in the hospital. If you think people don't actually do these things, did you carefully read the examples in the article? People are CALLING AN AMBULANCE because they ate bad food or want to know if they are pregnant. Seriously? People expect doctors to have all the answers, deliver quick and easy treatments, and threaten to sue if they are not satisfied or aren't told what they want to hear. Unfortunately, doctors feel obligated to search until they find something wrong because if they don't, patients aren't satisfied and that means a drop in patient satisfaction scores (which will soon determine reimbursement for hospitals), lawsuits, etc. Again, if you think people don't actually do this, do you remember the person who sued a cable company because the cable was never turned off and they got too fat to work because they sat in front of the TV all day? Accountability people. People are so quick to blame their problems (not just health related) on every one else. Man up America!

Having worked in EDs in both the UK and the USA one of the most striking differences is the Triage RNs ability to tell patient that they should have gone to their GP instead ( NHS).... and that you will have to wait if you want to be seen and the wait is going to be 4 hours for your sore throat......

i also agree that as a health care professional, you should have enough sense not to go to work and spread it to people. they may not be sick when they come in, but it sounds like they're likely to pick something up if nurses are so hardened they forget basic epidemiology.

Thank you--I believe since our society is still deeply victimized, and we're in a victimization/enabling cycle, we get this as a result. We're all victimized, and we want to stay that way.

Here is the question:1. How do we remedy ills such as substance abuse and obesity? If you don't want to treat the problems in ERs and medical establishments, where are we going to figure it out?

2. Would you say the same for birth? What's your stance on home birth? Birth is a natural thing, it takes time and expertise, but perhaps not the standard medical model? It's not a problem, it's an event, yes?

3. What doctors go through is tough. I think a transition from emergency medical use is needed--clinics that are more affordable. Better information for patients about "when to come to the emergency room" and a team of people who are there to help direct non-emergency patients to where they are needed to go.

The biggest problem is parents allowing their children to sit on their lazy soft butt in front of a TV or computer 24-7.I know who kids who are so pale they remind me of vampires because they do nothing but sit,eat and play computer games. Soft is an understatement. The parents ALLOWING it is the problem.These kids couldn't survive anything if it required physical exertion.Soft as cotton and whine about anything under the sun that involves actual work and the spineless parents cater to it !